Minimally invasive total thoracoscopic fixation versus open fixation for multiple Rib fractures: Systematic review and meta-analysis of clinical outcomes.

Abstract

Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes. We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0). Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation. There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.